review | autoimmune hepatitis

There are so many varieties of hepatitis – the many viruses, drug-related, alcohol, parasites, ischaemia…and of course, autoimmune. After the recent wave of immunosuppressive therapies over the last decade, what’s the deal?

A couple of points from skimming through the article:

  • affects more women that men
  • often has no identifiable precipitant, but sometimes preceded by a virus or new drug
  • presents as persistently abnormal ALT or AST with hyperglobulinaemia
  • 25% asymptomatic at diagnosis, and can be can be acute or chronic in nature
  • diagnosis made with a combination of
    • laboratory
      • high ALT/AST
      • raised serum Ig
        • high IgA makes you think of steatohepatitis
        • high IgM classically associated with PBC
      • negative tests for viral hepatitis
      • high Ab
        • ANA
        • Anti smooth muscle
    • histology
    • clinical features
  • types (check out table 2 in the article
    • 1
      • presence of ANA (homogenous) or anti-smooth muscle
      • anti -SLA/LP is specific, but only present in 10-30% of cases
    • 2
      • anti-LKM1 or anti LC1

Check out the tables with the diagnostic criteria and scoring systems. The article also provides a nice overview of treatment, with an algorithm presented to simplify matters. 

  • treatment usually starts with prednisolone and azathioprine (remember to check TPMT first!)
  • liver biopsy can be used to monitor treatment
  • mycophenolate is an alternative if azathioprine is not tolerated
  • keep transplantation in the back of your mind

It’s a well written article, and most certainly worth the ten minute read – and copy some of those tables and diagrams into your own notes for later. Check it out at Gut, here

IMAGE Reytan


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